Fractures

A fracture is a broken or cracked bone. You can partially fracture a bone or it can completely break. Most fractures happen to children or elderly people because most young and middle-aged adults have stronger bones.

About bones

You have over 200 bones in your body that make up your skeleton. Your skeleton supports and protects the soft tissues in your body and allows you to move.

Bone is a living tissue with a soft centre of bone marrow that produces blood cells. Your bones have a hard outer surface called the cortex that contains minerals such as calcium.

If your bones are healthy, they’ll be strong and can bear a lot of weight and force. They do bend a little so sometimes you can apply force to a bone but it won’t break. But if you apply too much force, which can happen if you have an accident, or during a fall, you can fracture a bone. If this is severe, your bone can fracture into many pieces.

Types of fractures

You can get an open fracture or a closed one.

A closed fracture is when your bone breaks or cracks, but it doesn’t break through your skin.

An open fracture (also called compound fracture) is when a broken bone breaks through your skin.

These are more serious because you might develop an infection in the bone and wound.

There are also different types of fracture depending on how you break your bone, and if you break it across or along the bone.

A stress fracture is when you break your bone after repeatedly putting pressure on it. You can get this in your foot and toes if you exercise a lot.

A displaced fracture is when you break a bone and it makes your arm or leg (for example) look deformed. It doesn’t look usual as it could be bent, for example. A non-displaced fracture looks normal.

An impacted fracture is when bone fragments are driven into each other, which shortens your bone.

A comminuted fracture is where your bone breaks into three or more pieces.

A greenstick fracture is where your bone breaks on one side but is bent on the other. Only children get these fractures because they have softer bones.

A transverse fracture is when your bone has a horizontal break along your bone.

An oblique fracture is when you break the bone at an angle.

An intra-articular fracture is a fracture that extends into your joint.

Compression fractures are when you get broken vertebrae in your spine. The vertebrae (back bone) collapse onto itself and get squashed.

Symptoms of fractures

If you have broken (fractured) a bone, the main symptom you’ll get is pain. This can be quite severe and it will be worse if you try and move the area. You might not be able to walk on a broken ankle, or use your hand if you have a broken wrist, for example.

Other symptoms of a fracture include:

swelling

bruising

the area looking deformed or twisted

You might hear your bone break during an accident or get a grating feeling.

If you think you have a fracture, go to your nearest accident and emergency (A&E) department. If you can’t move, call an ambulance. The paramedics in the ambulance will take you to hospital. The type of hospital they’ll take you to will depend on where your fracture is and the type of care that you need.

Diagnosis of fractures

A doctor at A&E will ask about your symptoms and examine you for signs of a fracture, such as swelling or tenderness. They’ll also ask you about your medical history, and if you’ve had an accident or fall.

You may have an X-ray to confirm if you have a fracture. Sometimes, you might have a scan, such as a magnetic resonance imaging (MRI) or computer tomography (CT) scan. These can produce a more detailed image of your bone.

Treatment of fractures

The aim of treatment is to put your bones back into place and then prevent them from moving until they heal.

First aid

If you think you’ve broken a bone, or you’re helping someone who has, try and support the affected area to stop it from moving around. This will help to prevent further damage and ease the pain. You can use cushions, clothes, or your hand to support the area. Or you can make a splint by rolling up a newspaper or magazine.

If you have an open fracture, don’t try to close the wound or put the bone back into place. Cover the wound with a clean dressing or cloth until you can get treatment.

Non-surgical treatment

Before your doctor can treat your fracture, they may need to move your bones back into their normal place. This is called reducing the fracture. This can be pretty painful so they might give you a general anaesthetic so you’ll be asleep and won’t feel any pain. Alternatively, you might have a local anaesthetic which will numb the area.

If you have a closed fracture, you can be treated with a cast or a brace, or by using traction. Each is described below.

A cast is a hard and rigid protective covering, which holds your bone in place and helps it to heal. Casts can be made of plaster of Paris or fibreglass.

A brace is similar to a cast but it allows you to move in a limited way.

Traction involves bringing your bones into line with each other using a gentle but steady pulling action. Your doctor will attach weights to your skin using tape, or to your bone using metal pins and these will help to gently pull your bones together. You might have traction before surgery. It’s most commonly used for leg fractures.

If you have a splint or cast support, it’ll usually enable you to go about your daily activities without any harm coming to your bone.

Some fractures, such as broken ribs, can’t be treated using a cast or traction because of where they are. You’ll probably be advised to take painkillers and to either rest, or do some physiotherapy exercises until the fracture heals.

Surgery

Depending on the type of fracture you have and how severe it is, you might need an operation to fix your bones into place. See our topic Surgery for a broken bone for information about what your operation will involve.

Physical therapies

As your fracture heals, you might need to see a physiotherapist. They can help you to build up strength and mobility in your bones and muscles, and ease any stiffness. They might give you an exercise programme to follow, which will help you to get back to your full range of movement.

Causes of fractures

There are lots of ways you can fracture a bone. The main ones are listed below.

The most common reason for broken bones is putting a severe force on them, which can happen during a fall or in an accident.

Health conditions that affect your bones, such as osteoporosis, can increase your risk of a bone fracture. This is because your bones become fragile and brittle, which means they’re more likely to break.

Your bones can fracture because of repeated stress on them, which is called a stress fracture. Stress fractures can develop in your lower legs, for example, if you run a lot. Soldiers sometimes get stress fractures in their feet from marching.

Complications of fractures

Most fractures heal without any further problems. But fractures can sometimes cause complications. The main ones are listed below.

When a bone fractures, it may damage surrounding nerves or a blood vessel. You may need an operation to repair this damage.

A fracture might not heal properly so your arm or leg, for example, might look unusual – it might be a bit bent or twisted. This is called malunion. If the bone doesn’t heal at all it’s called non-union.

A fracture can lead to compartment syndrome if your muscles swell up. Your muscles sit inside a compartment of tissue, so they don’t have much room to expand. When your muscles swell, the pressure increases and blood can’t flow into your muscles properly. This is extremely painful. You might need to have an operation to release the pressure on your muscle.

As time goes on, it’s possible to get other complications that include the following.

Joint instability. This can make it difficult to move as you did before you broke your bone.

Stiffness and an impaired range of movement. If you fracture a bone of a joint, such as in your knee, elbow or shoulder, it can affect other parts of your joint. Any scarring that happens when it heals can also lead to this.

Osteoarthritis. Breaking a bone that’s part of your joint can lead to this.

Recovering from a fracture

It’s normal to have swelling from your injury, particularly during the first few days after you break your bone. If you have a cast or splint on your arm or leg, this swelling can feel uncomfortable. To help any swelling go down, keep your arm or leg elevated for the first day or two. Gently move your uninjured fingers or toes to reduce stiffness. Go back to your fracture clinic or A&E department straightaway if:

any pain lasts longer than a few days or gets worse

your swelling doesn't go down

your wound or cast starts to smell, or you notice any discharge (pus)

your skin becomes red and tender around your wound, or burns or stings

you have any numbness in your arm or leg beyond the fracture

you’re unable to move your fingers or toes

you damage your cast

The time it will take for your bone to heal depends on your age, which bone you’ve broken and the type of fracture you have. In adults, it can take several weeks, or even months, for a fracture to heal fully. If a fracture is very slow to heal, it’s called a ‘delayed union’. See our FAQ: Healing times for more information.

After your cast, brace or metal rods are removed, you may not be able to go back to your usual activities for a while. Your muscles and joints may feel stiff and if you’ve had a cast or splint, you’ll have probably lost some muscle strength. Your doctor or physiotherapist will recommend some gentle exercise to help you to get your normal flexibility and muscle strength back.

After a few months, your bone will usually be as strong as it was before the fracture.

Frequently asked questions

Yes. You can lower your risk of fractures in later life by taking steps to build strong and healthy bones while you’re younger. There are also things you can do to reduce your risk of falling as you get older.

More information

There are lots of things you can do to help keep your bones healthy. The main ones are listed below.

Eat a healthy, balanced diet. Calcium is important to help keep your bones strong and healthy as are other vitamins and minerals.

Get enough vitamin D. This essential vitamin helps your body to use calcium. See our FAQs about vitamin D for more information.

Yes, a sprain can sometimes have the same symptoms as a broken bone. If you're not sure, speak to your GP or go to your nearest A&E department.

More information

A sprain is an injury to your ligaments – the strong fibres that hold your joints together. If you tear a ligament, you can sometimes get the same symptoms as a broken bone, particularly if it’s severe. These include:

swelling and bruising

pain

difficulty moving your joint – this may get worse over time until you can't move your joint at all

a popping feeling or sound at the time of the accident (if the ligament has broken)

It can be difficult to tell whether you’ve broken a bone or sprained a joint, so it's important to get medical advice. Speak to your GP or go to your nearest A&E department.

It's important to look after your cast and prevent it getting damaged so it can give your bones the support they need to heal.

More information

The purpose of your cast is to keep your bones still and in the right place so that they can heal properly. It can also help to ease your pain and reduce any swelling. If you damage your cast, it's less likely to give your fracture the support it needs.

Here are some tips to keep it in good condition.

Keep it dry. Put a couple of plastic bags (without holes in them) over your cast when you’re in the shower or bath.

Check your cast regularly for any damage or soft areas.

Check the skin around your cast regularly. Look for any signs of redness or irritation and check if it smells bad or has a discharge (pus).

Don’t be tempted to push anything down inside your cast to scratch an itch. This can hurt your skin and could even lead to an infection. If your skin is really itchy, see your doctor.

If your cast is damaged or uncomfortable, go back to the accident and emergency (A&E) department or your fracture clinic.

This varies depending on your age, which bone you’ve broken and the type of fracture you have. In adults, it can take anything from several weeks to months to heal fully.

More information

There are some general figures for how long it takes different types of bone to heal. For example, if you fracture:

bones around a joint, it will take about six weeks to heal

the shaft of a long bone, it will take around 12 weeks to heal

your tibia (shinbone), it will take around 24 weeks to heal

It takes less time for children’s bones to heal. If a two year old breaks their shinbone, for example, it will take around three weeks to heal.

These are only general estimates and the exact time it takes for your bone to heal will be specific to you. Ask your doctor how long it will take.

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